Monday, May 07, 2007

“I sleep with a drug rep”

----is one of several conflict of interest disclosures given by Thomas P. Stossel, a participant in Medical Progress Today’s conflict of interest symposium. You can view a text only or slide version of his presentation. Although not against reasonable safeguards he effectively shatters some of the simplistic and extreme positions now being put forth concerning the interaction between medicine and industry.

Appropriate and reasonable concern about the influence of industry on science has swung to an unhealthy extreme. He notes “In the past we named sponsors of our research and education efforts to honor them. Now, all disclaimers to the contrary, we are forced to itemize sponsors so that the beholder can discount our words and our work and to satisfy a prurient interest in our earnings.”

Though Stossel isn’t advocating for non-disclosure he notes adverse consequences of our obsession with industry connections: “Nothing better illustrates how what we disclose demeans us than the call to have only the second best and the not so bright, persons free from all commercial interests, serve in advisory roles.” Is there support for this implication that exclusion of experts with industry connections leaves us with “second best and not so bright”? It was certainly true in the experience of New England Journal editors in 2002 who found they had to relax their policy banning commercial interests in order to find qualified authors for their drug therapy series.

Stossel addresses the selective outrage about conflicts of interest with this: “Interestingly, these authorities exempt the principal source of money exchange in medicine—clinical practice—from the segregation of production and promotion, even though promotion of clinical services is routine.”